Provider Demographics
NPI:1871614602
Name:GOVIL, SUMITA (MD)
Entity type:Individual
Prefix:
First Name:SUMITA
Middle Name:
Last Name:GOVIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7676
Mailing Address - Country:US
Mailing Address - Phone:513-282-7911
Mailing Address - Fax:513-282-7900
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:SUITE 2700
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7002
Practice Address - Country:US
Practice Address - Phone:513-282-7911
Practice Address - Fax:513-282-7900
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39311207Q00000X
OH35-089177207QG0300X
OH35.089177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100017320Medicaid
OH2737131Medicaid
OHGO4208002Medicare PIN